- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.66 / $408.59 / $2,118.75
| Professional | | $230.66 | $408.59 | $2,118.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.02 / $1,243.02 / $1,267.55
| Facility | | $1,243.02 | $1,243.02 | $1,267.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.51 / $551.51 / $1,332.02
| Facility | | $551.51 | $551.51 | $1,332.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.76 / $453.08 / $740.33
| Professional | | $157.76 | $453.08 | $740.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.51 / $551.51 / $1,332.02
| Facility | | $551.51 | $551.51 | $1,332.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.76 / $375.10 / $740.33
| Professional | | $157.76 | $375.10 | $740.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.38 / $329.51 / $761.30
| Professional | | $138.38 | $329.51 | $761.30 |